Chances are, you already know the symptoms of obstructive sleep apnea (OSA), which apply to both men and women—snoring, snorting, choking, gasping for air and going to the bathroom several times a night.
But if you’re a postmenopausal woman, there’s a new symptom to watch out for.
It’s something that you may never have experienced before menopause, or if you did, it happened when you were a kid—nocturnal enuresis (bed-wetting).
A NEW SYMPTOM
Patrick Koo, MD, assistant professor of medicine at Alpert Medical School of Brown University, and his colleagues analyzed data from 161,808 postmenopausal women who were part of the Women’s Health Initiative study. They found that the more traditional risk factors a woman had for OSA, the more likely she was to also urinate during her sleep.
In fact, women who had all six OSA risk factors included in the study—obesity, frequent snoring, restless sleep quality, sleep fragmentation, daytime sleepiness and high blood pressure—were seven times more likely to also wet the bed than women who had no risk factors.
Here’s a likely explanation of how it happens. With OSA, the soft tissue around your airway closes up when you relax during sleep, so you are gasping for air. “This ‘sucking’ motion causes the heart to stretch and release a protein that increases urine production,” explains Dr. Koo. Combine that with changes in the urinary tract in postmenopausal women, which make it easier to leak urine when the bladder is full, and the result can be bed-wetting during sleep.
A DANGEROUS CONDITION THAT’S OFTEN UNDIAGNOSED
Bed-wetting is embarrassing, of course, but it could be a positive thing if it helps more women discover that they have OSA, which robs the body of oxygen during sleep, contributing to high blood pressure, heart attack, stroke and early death.
Here’s why: Studies show that women tend to underreport common symptoms to their doctors, such as snoring, fatigue or frequent awakenings to urinate. “Either they’re embarrassed to tell others that they snore or wake up multiple times a night to urinate, or they’re not aware that these are symptoms of OSA,” says Dr. Koo. Worse yet, the OSA symptoms women may bring up to their doc, such as sleeping problems or low energy during the day, are often misdiagnosed. Doctors tend to assume they’re signs of depression or insomnia, which are more common in women than in men.
For these reasons, too many women aren’t getting the treatment they need for a dangerous health condition—especially after menopause, when the incidence of sleep apnea jumps in women. OSA affects 18 million Americans. It’s estimated that 2% of women have the condition, but in reality, the incidence is very likely higher, especially after menopause.
GETTING HELP
If you find yourself wetting your bed—even if you’re not sure if you snore—ask your doctor to evaluate you for obstructive sleep apnea.
If you are diagnosed with OSA, your doctor may prescribe a continuous positive airway pressure (CPAP) machine—a mask you wear when you go to bed that’s attached to a machine that ensures that you get the right amount of oxygen. There are other solutions as well, including an easier-to-use mandibular advancement device (MAD), which fits in the mouth like an orthodontic dental retainer. To learn more about treating sleep apnea, see Bottom Line’s Guide to Sleep Apnea.
Discovering that you have sleep apnea—and getting the right treatment for it—can bring a host of benefits. You’ll reduce your risk for high blood pressure, heart disease and stroke. You’ll breathe better, sleep more soundly and have more energy during the day. For many women, it may also mean keeping the sheets dry.